Childhood femoral hernia: a commonly misdiagnosed condition

Abstract

Femoral hernia is a rare surgical entity in the paediatric age group. The diagnosis is still a challenging issue. The aim of our study was to review our experience with femoral hernias in children during the past 21 years. We reviewed retrospectively the medical records of all patients who underwent femoral hernia repair in our institution between 1980 and 2000. Thirty-eight children (20 females, 18 males) with the median age of 5.5 years underwent 42 femoral hernia repairs over a 21-year period. Correct preoperative diagnosis was obtained in 20 (53%) cases. Of the 18 (47%) misdiagnosed cases, 11 were found to have a femoral hernia at negative exploration for a clinically diagnosis of inguinal hernia and 7 were found to have a femoral hernia 1 week to 18 months (mean 2.5 months) post repair of a presumed inguinal hernia. Median follow-up time was 12 years (range, 6 months-22 years). Recurrent femoral hernias occurred in five (13%) patients 6 months to 3 years (mean 13.5 months) after initial hernia repair. This study shows that femoral hernia is still a commonly misdiagnosed condition. A correct preoperative diagnosis will lead to appropriate surgical management, thus avoiding unnecessary morbidity and preventing unnecessary reoperations.

A new minimally invasive technique for the repair of femoral hernia in children

“…Possibly the first description of FH in children is found in Sir Astley Paston Cooper's report of 2 girls with FH in 1827 [6,12,19].…”

“…Because of its rarity, misdiagnosis occurs in more than half of the cases [3,12]. Some FHs are diagnosed pre-or perioperatively, but an important number is discovered only at the time of groin hernia "recurrence" [4,9,12].…”

Laparoscopic inguinal hernia repair—a prospective personal series of 542 children

“…It has been shown that with open surgery, femoral hernias are diagnosed correctly in only 53%, and that the recurrence rate is 13% [10]. With laparoscopy, the correct diagnosis is straightforward [11].…”

Laparoscopic inguinal hernia repair in the pediatric age group—experience with 437 children

“…Beyond detection of PPV, the laparoscopic approach of hernia repair has additional advantages over open hernia repair as it is also helpful in detecting direct, femoral, and combined hernias [8,9]. Another advantage of this technique is that vas deferens and spermatic vessels are not dissected (especially useful when dealing with a case of recurrent hernia following either open or previous laparoscopic repair).…”